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Depression is the second-leading cause of disability among older patients worldwide. This study examined the effectiveness of the Integrated Care Model (ICM) intervention in decreasing depression, suicide ideation, and psychological symptoms and improving life satisfaction among old patients with depression living in communities. The participants were allocated to either the intervention (n = 67) or control group (n = 76) from July 2018 to November 2018. All participants received the usual geriatric care for three months in eastern Taiwan. Additionally, participants in the intervention group were treated according to the ICM, including the assessment and management of health problems, improvements in spiritual and mental wellbeing, helping with activities of daily life and mobility, providing social welfare resources, and prevention of elder abuse. The patients in the experimental group showed significant improvement in the group-by-time effect on the Center for Epidemiologic Studies Depression Scale, the Brief Symptom Rating Scale, suicide ideation measures, and the Life Satisfaction Index over 18 weeks. The ICM should be included in routine geriatric care and adopted in hospitals, long-term care facilities, and communities

BACKGROUND Limited evidence suggests variation in mortality of older critically ill adults across Europe. We aimed to investigate regional differences in mortality among very old ICU patients. METHODS Multilevel analysis of two international prospective cohort studies. We included patients ≥80 yr old from 322 ICUs located in 16 European countries. The primary outcome was mortality within 30 days from admission to the ICU. Results are presented as n (%) with 95% confidence intervals and odds ratios (ORs). RESULTS Of 8457 patients, 2944 (36.9% [35.9-38.0%]) died within 30 days. Crude mortality rates varied widely between participating countries (from 10.1% [6.4-15.6%] to 45.1% [41.1-49.2%] in the ICU and from 21.3% [16.3-28.9%] to 55.3% [51.1-59.5%] within 30 days). After adjustment for confounding variables, the variation in 30-day mortality between countries was substantially smaller than between ICUs (median OR 1.14 vs 1.58). Healthcare expenditure per capita (OR=0.84 per $1000 [0.75-0.94]) and social health insurance framework (OR=1.43 [1.01-2.01]) were associated with ICU mortality, but the direction and magnitude of these relationships was uncertain in 30-day follow-up. Volume of admissions was associated with lower mortality both in the ICU (OR=0.81 per 1000 annual ICU admissions [0.71-0.94]) and in 30-day follow-up (OR=0.86 [0.76-0.97]). CONCLUSION The apparent variation in short-term mortality rates of older adults hospitalised in ICUs across Europe can be largely attributed to differences in the clinical profile of patients admitted. The volume-outcome relationship identified in this population requires further investigation.

Background To identify the capsule enlargement index after femtosecond laser-assisted anterior capsulorhexis in 2–6-year-old children who underwent congenital cataract surgery. Methods In this prospective case series study, femtosecond laser-assisted anterior capsulorhexis was performed in patients with congenital cataract, aged 2–6 years. The actual achieved capsulorhexis diameters were measured with Digimizer version 4.2.6. Correlation coefficient (r) and multiple linear regression analysis were used to evaluate the variables that could potentially influence anterior capsulorhexis enlargement index (E). Results This prospective study enrolled 28 eyes of 22 patients with congenital cataract. The mean age of the patients at surgery was 4.67 years ±1.54 (standard deviation [SD]). “E” of the 28 cases was 1.211 ± 0.039 (SD). Correlation analysis showed that “E” correlated significantly with the anterior chamber depth (ACD) (r = − 0.469, p = 0.021) and axial length (AL) (r = 0.452, p = 0.027). The following formula was developed by using multivariable linear regression analysis: Predicted E = 1.177–0.052 × ACD + 0.009 × AL, R2 = 0.346 (F = 4.396, p = 0.046). Conclusions The anterior capsulorhexis enlargement index and its calculation formula could help to set up an accurate programmed capsulorhexis diameter for femtosecond laser-assisted congenital cataract surgery in children aged 2–6 years. Thus, an appropriate actual capsulorhexis diameter could be achieved.

Patients with cancer have a high risk of intubation, intensive care unit admission, or death from the coronavirus disease (COVID-19); age and comorbidities are additional risk factors. Vaccination is effective against COVID-19; however, patients with cancer have been excluded from pivotal clinical trials for COVID-19 vaccines. Data on COVID-19 vaccination in cancer patients who are older are lacking. This observational study was conducted to evaluate the seropositivity rate and safety of a two-dose regimen of the BNT162b2 or mRNA1273 vaccine in older patients (age ≥ 70 years) with solid tumors or with hematological malignances who are undergoing active anticancer treatment or whose treatment has been terminated within 6 months of vaccination. The control group was composed of healthy volunteers that were age-matched with the patient group. The primary endpoint was the seropositivity rate, and the secondary endpoints were safety, the factors influencing seroconversion, the IgG titers of patients versus healthy volunteers, and post-vaccine COVID-19 infection between 20 March 2021 and 14 July 2021. At our Institution (Oncology and Hematology Department, Hospital of Piacenza, North Italy), 443 patients with cancer underwent a program for COVID-19 vaccination; 115 (25.95%) were older than 70 (range 71–86 years) and form the basis of this study. All 115 patients accepted the vaccination. There were 64 female patients (55.65%), 94 patients (81.74%) with solid tumors, and 21 patients (18.26%) with hematological malignances. The primary endpoint of seropositivity was observed in 75 patients (65.22%)—70.21% in patients with solid tumors and 42.86% in patients with hematological malignances—versus in 100% of patients in the control group. Of the secondary endpoints, no grade 3–4 side effects and no COVID-19 infections were reported. The factor influencing seroconversion was the type of cancer. The patients’ median IgG titers were significantly lower than in the control groups. The COVID-19 vaccines BNT162b2 and mRNA1273 were effective and safe among older patients with cancer when administered in real-world conditions.

This research was conducted on 12 old patients of both sexes at the Prince Rashid military hospital between July 2003 and July 2004. Under spinal anaesthetic, an open reduction for a femur fracture neck was performed using only 1ml plane bupivacaine 0.5 percent at the L2-L3 intervertebral regions.

Background Percutaneous transluminal angioplasty (PTA) improves limb salvage rates in patients with severe lower extremity arterial disease (LEAD). It remains unknown whether PTA can be safely performed to the older LEAD patients. Purpose We investigated the effect of age ≥85 vs Methods We analyzed 222 LEAD patients from our previous retrospective cohort study between 2013 and 2018. All patients received percutaneous transluminal angioplasty. Study outcomes were in-hospital mortality and 1-year all-cause mortality and major adverse limb events (MALEs). Results The study included 222 patients aged 74±11 years (54% male), and 12.6% had acute limb ischemia. The older group had significantly higher rates of in-hospital (17.8 vs. 5.1%, P=0.009) and all-cause mortality (37.8% vs. 19.2%, P=0.016), but MALEs were not different significantly (8.9% vs. 16.9%, P=0.247). In multivariate logistic regression analyses, age ≥85 years was not associated with the increased risks of the study outcomes after we adjusted for potential confounders. The risk factors associated with 1-year all-cause mortality was the presence of acute limb ischemia (adjusted HR: 2.978, 95% CI: 1.502–5.905, P=0.002) and Rutherfold stages (adjusted HR: 2.135, 95% CI: 1.248–3.652, P=0.005). Conclusion Compared with the patients aged less than 85 years, the LEAD patients aged more than 85 years had favorable risks of mortality after receiving PTA, and the incident MALEs were not significantly different. Funding Acknowledgement Type of funding sources: None. Study outcomes in LEAD patients

Dear Editor,The need for exercise has been emphasised in both young and old patients with rheumatic diseases [1–3]. However, the same thing obviously applies to healthy young people if they do not ...

Introduction It is well recognised that cleft lip and/or palate carries an increased risk of developing dental caries. This article describes a service evaluation that was undertaken at the South Thames cleft service to analyse whether the five-year-old cohort of patients attending the clinic were following preventative advice as well as whether they were registered with a general dental practitioner and attending for regular recall. Methods A total of 96 patients were assessed. Data from a 24-month period were collected retrospectively using a data collection sheet. Results The vast majority (92%) of the patients included in this service evaluation were registered with a general dentist. Despite this, 40% had a decayed/missing/filled teeth score of >0, only 73% were having fluoride varnish applied regularly and 79% were using toothpaste containing the recommended fluoride content. More than half (57%) of the patients had developmental defects of enamel. Conclusions There needs to be increased emphasis on following national prevention guidelines given that this group of patients is known to be at a higher risk of dental caries. Parents and carers must be made aware of the requirement for shared care between general dental practitioners and secondary care.

Shatavari (Asparagus racemosus) is used by children for increasing strength, in young and middle-aged men as an aphrodisiac, in mothers as a galactogogue and in old patients as an anti-ulcer. Whereas, Safed Musali (Chlorophytum species) is primarily used only as an aphrodisiac due to its high steroidal content, which may cause severe side-effects when consumed by children, women and geriatric patients. However, market formulations of A. racemosus are often mixed with Chlorophytum species, and vice-versa. The present work aims at chromatographic detection and isolation of a marker compound from Chlorophytum species, so that its adulteration in A. racemosus can be detected. Petroleum ether extracts of market samples of A. racemosus and Chlorophytum species were subjected to TLC using the mobile phase n-hexane: diethyl ether: glacial acetic acid (7: 3: 0.1). This was followed by preparative TLC of Chlorophytum species extract, isolation of the spotted marker, its H1 NMR & GC-MS study, and finally its structure elucidation. A spot was observed in TLC of Chlorophytum species extract but not in A. racemosus extract, indicating it to be the marker which distinguishes the two species. Spectral analysis revealed the isolated marker to be 2, 4, 6, 10, 18, 22-tetracosahexaene. This work will be very useful to herbal industries and testing laboratories in detection of adulteration of A. racemosus formulations by Chlorophytum species, which will also benefit the patients. Such measures of standardization and quality control are also necessary to justify the authenticity of the Indian traditional system of medicine.

Introduction: Nasal nitric oxide (nNO) is extremely low in individuals with primary ciliary dyskinesia (PCD) and is recommended as part of early workup. We investigated the results of a former study whether tidal breathing sampling for a few seconds and vacuum sampling was as discriminative between PCD and healthy controls (HC) as conventional tidal breathing sampling (cTB-nNO) for 20–30s. Methods: We performed very rapid sampling of tidal breathing for 4 s (TB-nNO4sec) and vacuum sampling with applied negative pressure (TB-nNOvac; negative pressure was applied by pinching the sampling tube) for Results: We included 5 patients with PCD, median (IQR) age of 1.2 (0.3-4.1) years and 13 HC, 3.4 (1.3–4.4) years and 8 patients with cystic fibrosis (CF) as a disease control group, 2.4 (0.4–2.9) years. Measured nNO values with TB-nNO4sec and TB-nNOvac showed similar and comparable results to cTB-nNO measurements (HC4sec: p = 0.11, HCvac: p = 0.87, PCD4sec: p = 0.56, PCDvac: p = 0.23, CF4sec: p = 0.38, CFvac: p = 0.06). Conclusion: TB-nNO4sec and TB-nNOvac were comparable to cTB-nNO. TB-nNO4sec and TB-nNOvac requires only a few seconds of probe-in-nose time and is feasible for preschool kids and infants (0-5 years). Rapid TB-nNO sampling needs standardization and further investigations. Keywords: Primary ciliary dyskinesia · Nasal nitric oxide · Rare lung diseases · Pediatrics · Cystic fibrosis

INTRODUCTION Outcomes in old patients with upper gastrointestinal bleeding (UGIB) have been scarcely studied. Our aim was to compare very old individuals (>80 years old) with younger patients with UGIB, and to identify risk factors for the main outcomes. METHODS A single-centre prospectively collected database was analysed. Descriptive, inferential and multivariate logistic regression models were performed. Main clinical outcomes were in-hospital and delayed 6-month mortality. RESULTS 698 patients were included, 143 very old and 555 aged

Mini-Percutaneous Nephrolithotomy (M-PCNL) and Retrograde Intrarenal Surgery (RIRS) are commonly used methods in treatment of kidney stones. The aim of our study is to compare the efficacy and safety of M-PCNL and RIRS in kidney stone treatment over 50 years old patients. A total of 125 patients, 65 of whom had RIRS, and 60 of whom had M-PCNL, were included in the study. Age, gender, BMI (Body-Mass Index), ASA (American Society of Anesthesiology) scores of the patients; stone size, stone location, operation side, ESWL history, HU (Hounsfield Unit) values, hospital stay durations, SFR, complication rates according to Clavien modification system, postoperative hemoglobin loss, postoperative transfusion rates, and patients who needed a secondary operation were recorded. SFR values were calculated in the postoperative third and sixth months. The data between the two groups had similar characteristics in terms of age, gender, BMI, HU, stone size, operation side, stone location, ESWL history, operation time, postoperative transfusion rate, postoperative Clavien complications ( p > 0.05). When the ASA categories were evaluated, the mean ASA scores, ASA I, and ASA II data had similar characteristics in both groups ( p > 0.05). When the ASA 3 scores were evaluated, the number of ASA III patients in the RIRS group was statistically significantly higher ( p

Objective: To investigate the effectiveness of the Pavlik harness (PH) in the treatment of patients who were diagnosed with unstable hips aged between three and six months. Material and Method: We retrospectively reviewed patients aged three to six months who were diagnosed with unstable hips and treated with the PH. The patients were treated using PH and were closely followed by a weekly clinical examination. The primary outcome was to assess the success rate of PH treatment in children with unstable hips (Graf Type IID, III, IV). A successful outcome as a result of PH treatment was defined as either obtaining a Type I hip based on Graf’s method of hip ultrasonography or a concentric reduction based on hip radiography. Results: Thirty-three patients’ 34 hips were included in this study with a diagnosis of DDH based on hip sonography performed according to the Graf’s method at the time of initial admission to our department. The mean age of the children in the beginning of the PH treatment was 17 weeks (range, 14–22); the mean follow-up was 48 months (range, 24–84). On admission, the mean alpha angle was 46 (range, 35–58). According to the Graf classification, DDH was determined as Type D in 18 hips (52%), Type IIIa in 5 hips, Type IIIB in 3 (24%) and Type IV in 8 (24%). Of these 34 hips, 28 (82%) were treated successfully using PH, with a mean application time of 11.24 weeks (range, 4–20). The success rate of PH treatment was determined as 82% (28/34 hips). Conclusions: Favorable outcomes can be expected from PH treatment in patients with unstable hips (Graf Type IID, III, IV) who are diagnosed between the age of three and six months.

Purpose: Old (>64 years) and very old (>79 years) intensive care patients with sepsis have a high mortality. In the very old, the value of critical care has been questioned. We aimed to compare the mortality, rates of organ support, and the length of stay in old vs. very old patients with sepsis and septic shock in intensive care.Methods: This analysis included 9,385 patients, from the multi-center eICU Collaborative Research Database, with sepsis; 6184 were old (aged 65–79 years), and 3,201 were very old patients (aged 80 years and older). A multi-level logistic regression analysis was used to fit three sequential regression models for the binary primary outcome of ICU mortality. A sensitivity analysis in septic shock patients (n = 1054) was also conducted.Results: In the very old patients, the median length of stay was shorter (50 ± 67 vs. 56 ± 72 h; p < 0.001), and the rate of a prolonged ICU stay was lower (>168 h; 9 vs. 12%; p < 0.001) than the old patients. The mortality from sepsis was higher in very old patients (13 vs. 11%; p = 0.005), and after multi-variable adjustment being very old was associated with higher odds for ICU mortality (aOR 1.32, 95% CI 1.09–1.59; p = 0.004). In patients with septic shock, mortality was also higher in the very old patients (38 vs. 36%; aOR 1.50, 95% CI 1.10–2.06; p = 0.01).Conclusion: Very old ICU-patients suffer from a slightly higher ICU mortality compared with old ICU-patients. However, despite the statistically significant differences in mortality, the clinical relevance of such minor differences seems to be negligible.

A study on waiting time of patients in outpatient department was conducted in this hospital of northern India, with an aim to assess the services of outpatient department & suggests new ways to improve the health care system through research. A 100 respondents were chosen randomly from a pool of patients who visit the various OPD. The data was collected through questionnaire and interview. Results: The study revealed 62 were male and 38 were female, 26 were below age 30 yrs & 40 were between age 30-50 yrs and 34 were above 51 yrs of age. The majority were married 76%. The 55% were local and 45% were from out station. The 37% were new registration and 63% were old patients. The majority (95) had spent less than 30 min at the registration and 49% has consultation time more than 30 min. The time spent in laboratory and radiodiagnosis for more than 30 min by 12% and 29% respectively. The various factors like overlaps of round & OPD time, transportation time of sample and preparation time in radiology has been pointed out as major problem area. Conclusion: Queuing method, advanced simulations & real time waiting system will be immensely helpful to provide efficient & appropriate health care. Keywords: OPD, Waiting time, Simulation, Screening, Queuing method.

The authors report a high prevalence of delirium in COVID-19 old patients admitted in an academic hospital. During the recent COVID-19 period, delirium was present in 38% of old patients admitted with delirium at the COVID ward of the Erasmus MC University Medical Center of Rotterdam. We do not know in which patients COVID-19 can cause delirium; however, considering the high prevalence of delirium in COVID-19 old patients and the potential serious consequences, attention is needed in order to reduce disability and mortality in this vulnerable category of patients.

CT Scan for head data for children have been processed by using a software name IndoseCT. CT Scan usually use for diagnose part of human body, but CT Scan for head is the most. Data processing was carried out with the IndoseCT software to obtain effective dose values. The highest effective dose value with contrast and non contrast received by 1 until 5 years old patients. Examination with contrast has an effective dose value of 1.29 mSv and for non contrast examination has an effective dose value od 1.16 mSv, meanwhile the lowest effective dose for examination with contrast received by 0 until 1 years old patients with value of 0.94 mSv and for non contrast examination of 0.9 mSv received by 16 until 18 years old patient.

Demographic data record an increasing number of people aged over 65 years, with specific health conditions and a high probability to suffer from chronic diseases, cognitive impairment or loss of autonomy, and with limited functional reserve. The prevalence of disability increases with age, affecting 33% of men and 42% of women aged over 85 years. Many neurodegenerative disorders increase in prevalence with age. Thus, the need for rehabilitation treatment in this segment of population is very high, loss of functioning being the most prominent condition for admitting elderly persons in rehabilitation facilities. Rehabilitation in the elderly is an important tool in regaining autonomy, associated with substantial reduction in the burden of health and social costs. Patients aged over 80 years need a comprehensive geriatric assessment (CGA) to establish the global capabilities of the person for inclusion in a coordinated therapy plan and a long term follow-up. CGA will identify patients with severe or complicated medical conditions and important disability who require a multidisciplinary team and a coordinated rehabilitation program, accessible only in rehabilitation hospitals. Rehabilitation treatment should start from the intensive care unit, and continues until the patient reaches a plateau of maximal functional improvement. The most useful therapeutic interventions in old people are physical and occupational therapy, and, for selected and stable patients, therapy in a balnear resort is an option to improve their quality of life. Key words: geriatric population, rehabilitation, loss of autonomy, old patients

Objective. To enhance the reliability of visual analysis of X-ray mammograms, by applying the mathematical models of neoplasms and a method for their processing based on the mathematical apparatus of contour analysis.Material and methods. Two data sets were generated from X-ray mammograms obtained from 38–82 year old patients at routine examinations in the Republican Oncology Dispensary. The first set contained 100 packages of X-ray mammographic images that failed to reveal abnormal malignant changes. The second set was represented by 168 packages of X-ray mammographic images showing morphologically verified breast cancer. All the packages of mammographic images are presented in the standard direct craniocaudal and mediolateral oblique projections. The images were obtained using an analog mammograph. Digital copies of images having a resolution of 600 dpi were obtained for subsequent computer processing. The latter of digital mammographic images involved segmentation of space-occupying lesions, determination of the linearity factor of their outlines, and differential diagnosis of space-occupying lesions based on the calculated value of the linearity factor of their outlines.Results. An algorithm was elaborated for identifying the outlines of space-occupying lesions on X-ray mammographic images. The sequence of complex-valued vectors approximating its curve was used as a mathematical model of the outline. The concept on the outline linearity factor, which quantitatively characterizes its shape, was introduced. A method was developed for the objective classification of malignant and benign space-occupying lesions based on the value of the introduced linearity factor. The outlines of benign space-occupying lesions in the breast were ascertained to be characterized by the higher linearity factor (in the region of 0.3–0.4) (BI-RADS category 2), while the outlines of malignant tumors had a much lower value of this factor (in the order of 0.05–0.1) (BI-RADS categories 4–5). The main quantitative measures (sensitivity, specificity, and accuracy) of the informative value of the proposed method were determined. The latter was shown to have a higher specificity than the traditional visual analysis carried out by a radiologist. This allows the proposed method to be used as an additional procedure in the visual analysis of mammograms to enhance the reliability of clinical findings.Conclusion. The practical value of the method is in quantitatively evaluating the shapes of malignant breast neoplasms, in reducing the performance of a mammographic examination, and in increasing its objectivity. The proposed method makes it possible to reduce the time of analyzing X-ray mammograms and to enhance the reliability of clinical findings.

Background Intrahepatic cholangiocarinoma (ICC) has a rising incidence in western countries. Often major or extended resections are necessary for complete tumor removal. Due to demographical trends the number of elderly patients diagnosed with ICC is rising accordingly. Aim of this study is to show whether resection of ICC in elderly patients is reasonable or not. Methods Between January 2008 and June 2018 all consecutive patients with ICC were collected. Analyses were focussed on the performed resection, its extent, postoperative morbidity and mortality as well as survival. Statistics were performed with Chi2 test for categorical data and for survival analyses the Kaplan Meier model with log rank test was used. Results In total 210 patients underwent surgical exploration with 150 resections (71.4%). Patients were divided in 70-years cut-off groups (> 70 vs n = 23), middle-age (50–70, n = 76) and old (> 70, n = 51) group, whose results are presented here. Resectability (p = 0.709), extent of surgery (p = 0.765), morbidity (p = 0.420) and mortality (p = 0.965) was comparable between the different age groups. Neither visceral (p = 0.991) nor vascular (p = 0.614) extension differed significantly, likewise tumor recurrence (p = 0.300) or the localisation of recurrence (p = 0.722). In comparison of patients > or p = 0.047). For overall survival (OS) a benefit could be shown, but without reaching significance (p = 0.072). In subgroup analysis the middle-age group had significant better OS (p = 0.020) and RFS (p = 0.038) compared to the old group. Additionally, a better OS (p = 0.076) and RFS (p = 0.179) was shown in comparison with the young group as well, but without reaching significance. The young compared to the old group had analogous OS (p = 0.931) and RFS (p = 0.845). Conclusion Resection of ICC in elderly patients is not associated with an increased perioperative risk. Even extended resections can be performed in elderly patients without obvious disadvantages. Middle-age patients have a clear benefit for OS and RFS, while young and old patients have a comparable and worse long-term outcome.

There is little data regarding the impact of patient age on the physical and psychological effectiveness of cardiac rehabilitation (CR). The aim of the present study was therefore to compare the effects of an exercise-based CR program on physical and psychological parameters in young, old, and very old patients. We also aimed to identify the features that best predicted CR outcome.A total of 733 patients were divided into 3 subgroups: YOUNG (65 years old), OLD (between 65 and 80 years old), and VERY OLD (≥ 80 years old). Physical variables such as peak workload and estimated peak VOPerformance in all tests and scores for all questionnaires were significantly improved in all patients (P0.05). Age was significantly correlated with all the initial values (P0.05) but not with post-CR values. In addition, lower initial values of peak workload were associated with larger post-CR improvements irrespective of age. However, higher pre-CR anxiety and depression scores were associated with greater post-CR increases in physical performance in YOUNG and OLD patients, respectively.CR induced significant improvements of physical and psychological parameters for all patient groups. More interestingly, our results suggest that patients with the greatest physical impairments at baseline would benefit the most from CR, whatever their age. However, the value of initial mental state as a predictor of post-CR improvement depends on the age of the patient.

The aim was to describe the impact of infective endocarditis (IE) on functional, cognitive and nutritional statuses, and to estimate the influence of these parameters on surgical management and mortality.This was a prospective study over 13 months in 14 French hospitals, including patients ≥75 years of age with definite or possible IE. A comprehensive geriatric assessment (CGA) was performed during the first week of hospitalization, including a retrospective estimation of functional status 2 months before hospitalization, and 3 months after.A total of 120 patients were included (mean age 83.1 ± 5.0 (75-101) years). IE was associated with a dramatic impairment of functional status between 2 months prior hospitalization and the first geriatric evaluation (90.8% able to walk vs. 35.5% (p 0.0001), ADL (Activities in Daily Living) 5.0 ± 1.7 vs. 3.1 ± 2.1 (p 0.0001)). The 19 operated patients (15.8%) had less comorbidities (cumulative illness rating scale geriatric 10.8 ± 8.2 vs. 15.3 ± 7.1 (p 0.0176)), better functional (ADL 5.9 ± 0.4 vs. 4.9 ± 1.8 (p 0.0171) and nutritional (mini nutritional assessment 20.4 ± 5.0 vs. 17.3 ± 6.2 (p 0.0501)) statuses than non-operated patients. Among all infectious, cardiac and geriatric parameters, body mass index (HR 0.9, range 0.8-1, p 0.05) and ADL at the time of the first evaluation (HR 0.7, range 0.6-0.9, p 0.002) were the sole independent predictors of the 3-month (32.5%) and 1-year mortality (42.5%). Three months later, the 57 assessed patients only partially recovered their ADL (3.7 ± 1.9 vs. 5.3 ± 1.4 2 months prior hospitalization and 4.6 ± 1.9 at the first CGA; p 0.0001).Functional and nutritional abilities are crucial components that can be accurately explored through a CGA when managing IE in oldest patients.

Currently, people has been paying special attention to the problem of arterial hypertension (AH) in patients of the elderly and very old patients. The expected benefits from the treatment of AH compared to the potential harm in this age group of patients are increasingly being questioned, since they often have disturbed the mechanisms that maintain homeostasis and vital organ perfusion, especially pronounced in “frailty“ elderly and very old patients. Existing randomized clinical trials have shown that antihypertensive therapy in patients of elderly and very old significantly reduces cardiovascular morbidity, as well as cardiovascular mortality and all-cause mortality, however, the target blood pressure (BP) values are still debatable. A number of comorbidities also affect the determination of target levels of BP reduction. For example, AH is a major risk factor for its development and progression for chronic kidney disease (CKD). Therefore, it is important to understand the strategy of treating patients of elderly and very old with concomitant CKD. This article presents a review of the literature on target BP values in elderly and very old patients without frailty with diabetic and non-diabetic CKD. We reviewed data from large studies and meta-analyzes, assessing the relationship of more intensive compared with less intensive control of BP with a reduced risk of major cardiovascular events, mortality or changes in glomerular filtration rate. During the analysis of the literature, it was shown that the studies are extremely controversial: along with the benefits obtained in some of them from lowering BP of less than 130 mm Hg in terms of reducing mortality, cardiovascular risk and rates of progression of CKD, other studies have obtained results indicating not only the absence of these advantages, but also a clear advantage of higher target BP figures. Thus, there is a need for large, specially designed randomized clinical trials devoted to this issue.

Background This study aimed to retrospectively investigate the efficacy and tolerability of adjuvant chemotherapy in ≥70-year-old patients with stage IIA (T3N0M0) colorectal cancer. Methods Lymphovascular invasion, perineural invasion, margin positivity, dissected lymph node count of Results The study included 168 patients, among which 95 (56.5%) were male and 73 (43.5%) were female. The median age of patients was 73 years (range: 70–94). One hundred one (60.1%) patients were identified to have high risk. Eighty-one (87%) patients received 5-flourouracil+leucovorin and 12 (13%) patients received capecitabine regimens as adjuvant chemotherapy. The patients receiving capecitabine regimen had significantly higher rates of dose reduction at initiation and during the treatment. Among low-risk group, there was no statistically significant difference between patients with and without adjuvant chemotherapy in terms of disease-free survival or overall survival (p = 0.528 and p = 0.217, respectively). In high-risk group, patients receiving adjuvant chemotherapy significantly differed from those not receiving adjuvant chemotherapy in terms of median disease-free survival and overall survival (p = 0.009 and p Conclusion The findings of our study showed improved disease-free survival and overall survival in high-risk ≥70-year-old patients who received adjuvant chemotherapy due to T3N0M0 colorectal cancer. We believe that 5-flourouracil+leucovorin or capecitabine regimens should be recommended for these older high-risk patients who could receive adjuvant chemotherapy regardless of age.

Purpose:The aim of this study was to evaluate outcomes of internal fixation for displaced femoral neck fracture (FNF) between 50 and 60 years old. The patient and surgical factors for the failure were identified.Methods:We retrospectively reviewed the records of 102 displaced FNF patients between 50 and 60 years old (mean age 54.9 years) who had undergone internal fixation between 2005 and 2016. The minimum follow-up was 12 months. Primary end points included loss of reduction, non-union, and osteonecrosis of the femoral head (ONFH). Preoperative Pauwel’s angle, fixation timing and methods, reduction quality, removal of implant and medical comorbidities were analysed.Results:The overall failure rate was 44.1%. In multivariate logistic regression analysis, poor reduction quality (adjusted odds ratio [aOR] 4.38; 95% confidence interval [CI], 1.54–12.46) and internal fixation delayed more than 6 hours (aOR 3.24; 95% CI, 1.08–9.69) were risk factors for all causes of failure. In a stratified analysis, poor reduction quality (aOR 3.81; 95% CI, 1.11–13.04) and a history of alcohol dependency (aOR 4.91; 95% CI, 1.09–22.13) were risk factors for loss of reduction. Internal fixation delayed >6 hours (aOR 3.67; 95% CI, 1.05–12.77) and removal of implant (aOR 3.32; 95% CI, 1.02–10.77) were risk factors for ONFH.Conclusions:The outcome of internal fixation of displaced FNF in patients between 50 and 60 years old is suboptimal. The patient selection is important. Non-alcohol dependency lowered early failure. Implant retention reduced ONFH. Surgery within 6 hours and good quality of reduction yield better results.

Background: Oral squamous cell carcinoma (OSCC) most commonly occurs in the middle-aged and older individuals. It is believed thatrole of aetiologyisdifferent in young and old patients. Objective: This study was conducted to analyse the comparisonof demographic and aetiological difference in young and old patients of buccal mucosa cancer. Materials and Methods: In this retrospective study, demographicand aetiological details were retrieved form medical records between Mar. 2013 and Jan. 2016. Results: The patients were grouped as younger (

All living organisms are subject to the aging process and experience the effect of ionizing radiation throughout their life. There have been a number of studies that linked ionizing radiation process to accelerated aging, but comprehensive signalome analysis of both processes was rarely conducted. Here we present a comparative signaling pathway based analysis of the transcriptomes of fibroblasts irradiated with different doses of ionizing radiation, replicatively aged fibroblasts and fibroblasts collected from young, middle age and old patients. We demonstrate a significant concordance between irradiation-induced and replicative senescence signalome signatures of fibroblasts. Additionally, significant differences in transcriptional response were also observed between fibroblasts irradiated with high and low dose. Our data shows that the transcriptome of replicatively aged fibroblasts is more similar to the transcriptome of the cells irradiated with 2 Gy, than with 5 сGy.This work revealed a number of signaling pathways that are shared between senescence and irradiation processes and can potentially be targeted by the new generation of gero- and radioprotectors.

Elderly patients with end stage kidney disease represent a challenge for surgeons to create a vascular access. Determine predictive parameters functionality of the arteriovenous fistulas for hemodialysis in the elderly. The study was organized as a retrospective study at the Center for Dialysis, Clinic for Urology and Nephrology, Clinical Center Kragujevac. The study included patients older than 65 years with arteriovenous fistula thrombosis, in the period of four years, in which there is information on the length of the functioning fistula. The study included 48 patients, mean age 71.3±5.2 years, 29 (60%) men and 19 (40%) women. The data were analyzed according to gender and demographic structure, type of anastomosis, positioning, length of functioning fistulas, and the lumen diameter of the arteries and veins that are used to create a fistula. The median length of functioning arteriovenous fistula, based on Kaplan-Meier model, is 16 months (95% CI 6.9-25.1). Median functioning for proximaly located fistulas was 24 months (range, 1-259), while median functioning in patient with distally located fistulas was 8 months (range, 1-96). The difference in relation to the positioning of the fistula was statistically significant (p=0.006). In univariate Cox regression model, a statistically significant predictor of the functioning of arteriovenous fistulae is fistula positioning (B=0.700; p=0.022). The predictive parameter of survival of arteriovenous fistulas in elderly is proximally located fistula.

The aim of this study is to evaluate temperature measurement methods in children. Body temperatures of 3 to 18 years old patients were measured with a tympanic infrared thermometer, a noncontact infrared skin thermometer and with a temporal artery thermometer. While the specificity of temporal artery and noncontact thermometers were good in determination of temperatures above 37.5°C, their sensitivities were low. Positive predictive value and negative predictive value for both thermometers were sufficient. Both specificity and sensitivity of both thermometers were determined to be good at temperature values above ≥ 38°C. It is thought that noncontact and temporal artery thermometers can be used for screening in pediatric emergency departments.

Introduction: Colorectal cancer (CRC) is the second commonest malignancy related death in Western Europe with incidence increasing in young adults. 31% of UK patients with CRC present as emergencie...

Myelodysplastic syndromes (MDS) are characterized by ineffective hematopoiesis and risk of evolution to acute myeloid leukemia (AML) [1]. Presentation varies from mild cytopenia to profound symptom...

Background: The perforation of peptic ulcer is a common and serious life threatening surgical emergency. Up-till now no consensus was reached regarding the best practice in management of perforated peptic ulcer. The aim of this study is to evaluate and compare between both management strategies of perforated peptic ulcer; performing simple closure of the perforation with an omental patch then H. pylori eradication and inhibition of acid secretion using long time proton pump inhibitors versus performing definitive repair of perforated peptic ulcer (closure of the perforation with an omental patch, truncal vagotomy and gastrojejunostomy to discover a proper management strategy of perforated peptic ulcer. Patients and Methods: In the current study we included 30 patients which were divided into 2 groups: group 1 included 15 patients where we managed them by simple closure of the perforation with an omental patch then H. pylori eradication and inhibition of acid secretion using long time proton pump inhibitors and group 2 included 15 patients where we performed closure of the perforation with an omental patch, truncal vagotomy and gastrojejunostomy. Results: We found that younger patient underwent vagotomy and gastro-jejunostomy technique (p H. pylori infection and inhibition of acid secretion especially in old patients with comorbid condition who presented late or with shock.

Objectives: The aim of this study is to investigate the characteristics and surgical outcomes of acute type A aortic dissection (AAAD) in patients younger than 50 years of age. Methods: We retrospectively evaluated 307 patients who consecutively underwent surgical treatment for AAAD in our institute from January 2007 to June 2017. Patients were classified into two groups: the young group with 31 patients aged younger than 50 and the old group with 276 patients aged 50 years or older. Results: In-hospital mortality was similar in both groups (3.2% vs. 9.4%, p=0.19). Overall survival at 5 years was higher in the young group than that in the old group (97% vs. 71%, p=0.017). No significant differences were observed in freedom from aorta-related death and distal aortic reoperation at 5 years (97% vs. 87%, p=0.26; 86% vs. 92%, p=0.093). The percentage of young patients with postoperative patent false lumen at the descending aorta was significantly higher than that of old patients (76% vs. 30%, p

Objectives: To compare baseline characteristics of 10-17 yr old patients (pts) with T2D from different regions in clinical trials of sitagliptin as initial oral therapy (IOT, NCT01485614) or as add-on to metformin therapy (AMT, NCT01472367, NCT01760447). Methods: Demographic and baseline glycemic parameters of pts randomized in the US or Canada (NA), Latin America (LA), Europe or the Middle East (EM), or Asia Pacific (AP) were summarized by region (Table). Results: The proportion of males varied by region. While racial and ethnic distributions were generally reflective of region, the proportion of Whites in NA was higher than in other reports (e.g., ncbi.nlm.nih.gov/pmc/articles/PMC3038479). AP pts were youngest. Consistent with age, pts in AP were shorter, with lower weight and BMI across trials; however, median BMI percentile was >98% across regions and trial types. Median A1C and FPG ranged from 7.1-7.4% and 118-130.5 mg/dL (IOT) and 7.7-7.9% and 125.5-143.5 mg/dL (AMT). Despite having the lowest FPG, pts in AP (IOT) had the highest A1C. Conclusions: Despite regional differences in race, sex, and anthropometrics, pts were uniformly obese. Baseline glycemic parameters by region were generally comparable, although the younger age (all trials) and lower FPG and higher A1C (IOT) in AP pts may reflect a difference in the pathophysiology of T2D, with greater post-meal rather than fasting dysglycemia. Disclosure M. Y. Jalaludin: Advisory Panel; Self; Novo Nordisk, Research Support; Self; Novo Nordisk. Y. Zhang: Employee; Self; Merck & Co., Inc., Stock/Shareholder; Self; Merck & Co., Inc. Z. Xu: Employee; Self; Merck & Co., Inc., Stock/Shareholder; Self; Merck & Co., Inc. L. W. Scherer: Employee; Self; Merck & Co., Inc., Stock/Shareholder; Self; Merck & Co., Inc. S. S. Engel: Employee; Self; Merck & Co., Inc., Stock/Shareholder; Self; Merck & Co., Inc. K. D. Kaufman: Employee; Self; Merck & Co., Inc., Stock/Shareholder; Self; Merck & Co., Inc. R. Shankar: Employee; Self; AstraZeneca, Merck Sharp & Dohme Corp. A. Deeb: None. P. Zeitler: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Eli Lilly and Company, Janssen Research & Development, LLC, Merck & Co., Inc. R. Garcia: None. R. S. Newfield: Consultant; Self; Merck Sharp & Dohme Corp. Y. Samoilova: None. C. A. Rosario: None. N. Shehadeh: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Novo Nordisk, Sanofi, Research Support; Self; Novo Nordisk, Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Novo Nordisk, Sanofi. C. K. Saha: None. Funding Merck & Co., Inc.

EnglishObjective. Main objective was whether the combination of C-Reactive Protein (CRP) and Alvarado Score (AS) increase the diagnosis accuracy of AS among 2-to-20-year-old patients with suspected acute appendicitis presenting to Emergency Departments. Materials and methods. This is a secondary analysis of prospective cohort study consecutively including all patients from 2 to 20 years of age attended for suspected acute appendicitis in 4 Spanish Emergency Departments during 6-month period. We collected demographic, clinical, analytic and radiographic, and surgical data. AS categories were retrospectively calculated as low (0-4 points), intermediate (5-6 points) or high (7-10 points). The cut-off levels were >0.5 mg/dl for CRP. The outcome was diagnosis of acute appendicitis within 14 days of the index visit. Results. A total of 331 patients with suspected of acute appendicitis (mean age 11.8 (SD 3.8) years; 52.9% males) were recruited. According to AS, 108 (32.6%) were at low risk, 76 at (23.0%) intermediate risk and 147 (44.4%) at high risk of acute appendicitis. One hundred and sixteen (35.0%) cases had confirmed histopathological diagnosis of acute appendicitis. The AUCs of ROC were 0.76 (0.70-0.81) for AS and 0.79 (95% CI 0.75-0.84) for CRP-AS being the difference statistically significant (p=0.003). The CRP for diagnosis acute appendicitis in low risk AS group had negative predictive value of 95.8% (95%CI 87.3-98.9) and likelihood ratio negative of 0.4 (95%CI 0.2-1.0). Conclusions. CRP-AS has shown to increase the diagnostic accuracy of AS for acute appendicitis. This approach may be useful to rule out the diagnosis of acute appendicitis in paediatric patients attended for abdominal pain suggestive of acute appendicitis. EnglishObjetivo. El objetivo principal fue conocer si la combinacion de la proteina C reactiva (PCR) y la escala de Alvarado (AS) aumenta la precision de esta ultima en el diagnostico de apendicitis aguda en pacientes de 2 a 20 anos que son evaluados en los servicios de urgencias hospitalarios con esta sospecha clinica. Materiales y metodos. Se trata de un analisis secundario de un estudio de cohorte prospectivo que incluyo de forma consecutiva a todos los pacientes de 2 a 20 anos atendidos por sospecha de apendicitis aguda en 4 servicios de urgencias hospitalarios espanoles durante un periodo de 6 meses. Recopilamos datos demograficos, clinicos, analiticos, radiograficos